Billing Compliance

The worsening economy is taking its toll even on the best practices.

Times are tough, and layoffs may be unavoidable. If you must do it, here’s how to do it right - while protecting your practice from litigation.

Surgical package; billing family members; using 99211 for new patients

Most practices breathe a sigh of relief when a patient fails to show up for his appointment. But, those unfilled appointments add up quickly. Here's how to plug the holes in your schedule.

Dispensing vaccines is frustrating and expensive. Here’s a shot in the arm for vaccine management.

With prices low, it may seem like a great time to buy your office space. Be wary; the advantages to ownership, while real, are balanced with disadvantages and risk. Make sure your eyes are open.

Coding right for pelvics; special Pap, special coding; observation or inpatient?

Here's the scoop on reimbursement for your medical practice's EHR use if you meet the meaningful use requirements of CMS.

Here are a few tools and resources to get you started in understanding and complying with the FTC's new Red Flags identity theft rule.

Fifteen years after his 300-pound, 6’4” patient offered to toss him through his office window, psychiatrist Dennis Helmuth explains why he now looks forward to their appointments.

Which payers should you deal with and which should you drop? PayerView uses real claims data to rank them first to worst.

Billing “Incident-To;” Same Patient, New Problem; Moonlight Coding

I am about to become an employee of a group whose culture is to do “routine annual physicals” (RAP). I had mostly stopped doing physicals for patients with Medicare since physicals are usually not covered (unless by a secondary insurance or Medicare advantage plan).The group I will join usually bills Medicare for RAPs, using the 99215 code, plus an additional charge for (I think) 99397 or some other “preventive” code. Are other practices still using 99215 with Medicare patients? Have there been actions from the OIG to recover overpayments related to the use of 99215 for physicals? Can you offer suggestions that would help me get this clarified? It seems, for example, that an internal audit by someone familiar with Medicare rules would help either reassure me or make it clear that the group is not in compliance with Medicare rules.

Do I need a separate insurance policy for protection in case a HIPAA violation lawsuit is ever filed against me? It doesn’t seem like medical malpractice would cover this.

Appeal letter for prompt payment from your medical practice payers.

Here is a sample collections letter to use at your medical practice.

Collections Letter 3

Collections Letter 3 -- Spanish

Collections Letter 2 -- Spanish

Appeal Letter Justifying Emergency Treatment

Collections Letter 1 -- Spanish

If you can't verify a patient's insurance, their signature on this form shows they know they are responsible for payment.

Assignment of Benefits -- Spanish

Use this letter when a claim is denied because a patient saw a physician in your group who is not his or her designated primary care physician.

This Advance Beneficiary Notice form, created by CMS, is best managed by the clinical team at your medical practice versus the front office staff.